Managing hypertension among nursing-home residents and community-dwelling elderly in Germany: a comparative pharmacoepidemiological study

Abstract

Purpose: The purpose of this study was to investigate the adequacy of hypertension management in hypertensive elderly living in long-term-care facilities compared with home-living elderly.

Methods: This retrospective, cross-sectional, pharmacoepidemiological study compared data from a community-dwelling population (CD) and from four nursing homes (NH) in Dresden, Germany. Individuals aged ≥ 65 with the diagnosis of arterial hypertension were included. Demographical, medical, and drug prescription data as well as blood pressure (BP) values were analyzed and compared descriptively after matching the populations by age and gender.

Results: Each population comprised 209 patients (mean age 80.4 years [± 6], 70.3% women). NH showed a higher number of diseases [7 (5-9) vs. 5 (3-7); p < 0.001]. BP (<140/90 mmHg) was better controlled in NH (61.0% vs. 48.1%; p = 0.015). The median number of BP-lowering drugs was three (2-4; CD) and two (1-3; NH) (range: 0-9). Most frequently used antihypertensives were diuretics and beta-blockers. Among renin-angiotensin system (RAS) blockers, angiotensin-receptor blockers (ARBs) were preferred in CD and angiotensin-converting enzyme (ACE) inhibitors in NH. Drug treatment for secondary prevention of myocardial infarction or stroke [acetylsalicylic acid (ASA) 100, RAS-blocker, beta-blocker, statin] was low among both groups (CD 21.3%; NH 1.6%; p = 0.01). NH received more inappropriate drugs, especially tranquillizers (31.2% vs. 21.0%; p < 0.05) [according to the PRISCUS (Latin for "old and venerable") list for potentially inappropriate medications in the elderly (PIM)].

Conclusions: NH residents showed better BP control than CD elderly while receiving less antihypertensive drugs. The prescription of antihypertensives was assumed to be more cost effective in NH. Nevertheless, inappropriate drug use is still high (NH > CD), and there is an extended need for professional medication assessment in both groups of elderly.